Higher prices, fewer options lurk after health bill collapse

Soaring prices and fewer choices may greet customers when they return to the Affordable Care Act’s insurance marketplaces, in part because insurers are facing uncertainty about whether the Trump administration will continue to make key subsidy payments.

The health care law of the land has survived for now, but it needs help — and it needs it soon.

Soaring prices and fewer choices may greet customers when they return to the Affordable Care Act’s insurance marketplaces this fall, in part because insurers are facing deep uncertainty about whether the Trump administration will continue to make key subsidy payments and enforce other parts of the existing law that help control prices.

Assurances don’t look to be coming anytime soon. “As I said from the beginning, let ObamaCare implode, then deal. Watch!” President Donald Trump tweeted early Friday, soon after the Senate narrowly rejected the latest push to dismantle the Obama-era health care law.

Health and Human Services Secretary Tom Price said in a statement after the Senate vote that the Trump administration would pursue its health care goals through regulation.

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That kind of uncertainty rattles insurers, many of whom have already stopped selling policies through public insurance markets established by the health law because they were losing money.

Their main concern now is that the Trump administration will stop paying crucial subsides called for in the law that help reduce costs like deductibles for people with low incomes. The subsidies, estimated at $7 billion a year, have been challenged by Republicans in court, and Trump has only guaranteed them through this month.

If they stop, insurers will have to raise prices for coverage, known as premiums, because by law they must still offer the same reduced deductibles for their low-income customers.

Leerink analyst Ana Gupte surveyed several states and has said that insurers are asking for price hikes of around 36 percent when they assume the subsidies go away, compared with about 18 percent if they stay.

People with low incomes might be shielded from these hikes in part because the law provides tax credits that cover much of the premium.

But those who make too much to qualify for that help — and tend to vote Republican — could get hit hard, noted health care consultant Robert Laszewski, a former insurance executive.